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Group 2 PH - Left Heart Disease — EECC MCQ

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ModeratePulmonary Vascular DiseaseGroup 2 PH - Left Heart DiseaseEECC

A 70-year-old man with severe HFpEF (LVEF 55%, elevated E/e', LAVi 52 mL/m²) undergoes right heart catheterisation showing mPAP 32 mmHg, PAWP 22 mmHg, and PVR 1.8 Wood units. Which group of pulmonary hypertension does this represent?

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Correct answer: B — Group 2 PH (isolated post-capillary PH due to left heart disease)

This patient has isolated post-capillary PH (IpcPH) — Group 2 PH due to left heart disease. The haemodynamic criteria per the 2022 ESC/ERS PH Guidelines are: mPAP >20 mmHg AND PAWP >15 mmHg AND PVR ≤2 WU. The PAWP of 22 mmHg confirms left-sided disease as the cause (elevated LV filling pressures). The PVR of 1.8 WU is ≤2, indicating no significant pre-capillary component (if PVR were >2 WU, it would be combined post- and pre-capillary PH, CpcPH). Treatment is directed at the underlying LHD (HFpEF management). PAH-specific therapies are generally not recommended for Group 2 PH (Class III).

Reference: ESC/ERS (2022): Guidelines for Pulmonary Hypertension